test-tuition reimbursement form - General Building Contractors Association

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Tuition Reimbursement Pre-Registration Form

Note: You must apply with GBCA within 30 days of the start of your class, and your invoice and transcript must be sent to GBCA within 30 days of the completion of your course.

Name*
First Last

Address*
Street Address Address Line 2 City State ZIP Code

Phone*

Fax (optional)

Email*

Employment Information

Current Employer*

Address*
Street Address Address Line 2 City State ZIP Code

Phone*

Job Title / Position*

Date of Employment*
MM slash DD slash YYYY

Previous Employer (optional)

Address (optional)
Street Address Address Line 2 City State ZIP Code

Phone (optional)

Job Title / Position (optional)

Date of Employment (optional)
MM slash DD slash YYYY

Please specify only one course for which you wish to apply for reimbursement

Select a College*

Which Semester Will You Attend?*
Fall Semester
Spring Semester

List only one course for which you wish to apply for reimbursement*

By completing this information you authorize GBCA to obtain an official copy of your grades at the end of the semester. Questions may be directed to Marybeth Gerdelmann, Education & Workforce Development Associate, by email at or by telephone at (215) 568-7015.

*
Check this box if you agree with the terms above.

By agreeing with the terms below, I am indicating I understand that reimbursement will be contingent upon achievement of letter grade B or higher in the course listed on this application, that I am solely responsible for payment to the institution listed above for this course, that upon completion of the course I have thirty (30) day to provide proof of payment and an official transcript to GBCA. I understand I am solely responsible for the payment of any additional tuition cost or fees, including textbook costs and late fees. I understand that if I do not complete this course, for voluntary or involuntary reasons, I will be ineligible to participate in the GBCA Tuition Reimbursement Program for one year, effective from the date of this application.

*
Check this box if you agree with the terms above.

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